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Slouching Toward Disaster

Most of us do not ordinarily consider our lives to be at stake in matters of public policy. The prospect of an avian flu pandemic, however, puts us all in jeopardy, and if the dilatory response of the Bush administration proves fatal in this case as it did after August 2001, when the president was told that Osama bin Laden was about to strike within the United States yet did nothing, or in the years leading up to Hurricane Katrina, when engineers repeatedly warned that the levees in New Orleans were inadequate, we will pay an even greater price for our slothful, ideologically driven, and crony-ridden national leadership than in either of the epochal disasters that have so far befallen America in the Bush years.

Scientific concern about avian flu did not just emerge recently, though one might have thought so from the flurry of administration activity this past month. Nor is the concern about a pandemic solely the result of the appearance of the H5N1 virus and the high mortality rate among the small number of known cases. Flu pandemics are a recurrent historical phenomenon. The concern about flu is not like the anxiety about killer asteroids, which, it is true, have struck before -- millions of years ago. The flu pandemic that took 50 million to 100 million lives worldwide in 1918 was followed by lesser pandemics in 1957 and 1968. Scientists have told us for years that it was not a question of “if” but “when” another flu pandemic would strike.

Yet, in recent years, the United States allowed itself to become totally dependent on foreign manufacture of flu vaccine -- sources that would be grossly inadequate, in both quantity and speed of production, in the event of a pandemic. For national defense, we refuse to become similarly dependent on foreign suppliers of weapons; indeed, the Department of Defense tries to maintain more than one supplier for its various needs. Vaccines ought to fall under that same policy, and for much the same reason: Our lives may depend on the availability of multiple domestic sources in a crisis. Although one manufacturing facility for flu vaccine is now under construction in the United States, it will still leave us far short of the necessary capacity.

Conservatives, always ready to blame the tort system, say pharmaceutical manufacturers have fled the vaccine business because of the potential liability, and that if we want them to make vaccines, the government should absolve them of any liability for defects. But, as there is a serious risk of contamination in vaccine production, eliminating liability could invite new dangers. The real problem is that, given the size of the market, the commercial incentives to invest in vaccine development and production are incommensurate with the social need. Sales of all vaccines represent only 2 percent of the total market for pharmaceuticals. Unlike the most profitable drugs, which need to be taken frequently, a vaccine is typically given once or a few times. Every year, because of mutations in the virus, the flu vaccine must be changed, and the past year's unsold inventory becomes worthless.

This is an instance, in other words, where government has to provide the incentives -- and direction -- that the market cannot be expected to generate on its own. The threat of a flu pandemic demands large-scale public financial commitments, comprehensive planning, a crash effort to develop new vaccine technologies and build new facilities to produce both vaccines and antiviral drugs, and local public-health preparedness. Unfortunately, none of these things comes naturally or quickly to an administration averse to bold public action and in a society where public-health organization has suffered long neglect. Trying to assure the public he's on the case, the president has spoken of calling in the military to quarantine affected regions -- a display of his instincts that showed just how little he understands the problem.

No one knows whether the H5N1 virus will mutate into a form transmissible from one person to another or, if it will, how much time we have left to prepare. Now that scientists have reconstituted the 1918 virus, we know it was also a bird flu. A pandemic comparable to 1918 would take a toll in the tens of millions. And not just among the old and frail: The 1918 flu struck healthy young adults especially hard. The only rational course is to assume that H5N1 will become transmissible from person to person and to ramp up both longer-term scientific work and immediate international measures to slow the spread of the virus. A determined effort, albeit belated, may yet save humanity from an unimaginable catastrophe.

About the Author

Paul Starr is co-founder and co-editor of the The American Prospect. and professor of sociology and public affairs at Princeton University. A winner of the Pulitzer Prize for General Nonfiction and the Bancroft Prize in American history, he is the author of seven books, including most recently Remedy and Reaction: The Peculiar American Struggle over Heath Care Reform (Yale University Press, revised ed. 2013). Click here to read more about Starr.